Factors Associated with E-Cigarette Misconceptions and Intention to Use Among High School Students in Bangkok, Thailand: A PRECEDE-Based Study

Abstract

Introduction: Despite Thailand's comprehensive prohibition of e-cigarettes, adolescent usage persists as a significant concern, mostly attributable to misconceptions regarding safety, nicotine, addiction, cessation, and facilitated availability via digital marketing and social influence. This cross-sectional analytical study, informed by the PRECEDE model, investigated the predisposing, enabling, and reinforcing factors related to e-cigarette misconceptions among high school students in Bangkok. Objective: To investigate the social and behavioral determinants of e-cigarette misconceptions among Thai adolescents and identify characteristics that could guide focused public health interventions. A total of 441 participants in grades 10 to 12 were recruited using multi-stage cluster sampling from three schools in Bangkok. Results: Multiple linear regression indicated that predisposing factors accounted for 8.9% of the variance in misconceptions, with male gender, elevated grade, and higher GPA positively correlated, whereas a history of conventional smoking was negatively correlated; enabling factors accounted for the largest variance at 18.3%, with free giveaways and exposure to digital advertising significantly augmenting misconceptions; reinforcing factors accounted for 3.8% of the variance. Conclusion: Targeted digital marketing, illegal accessibility, peer influence, and gender related attitudes significantly contribute to e-cigarette misconceptions, suggesting that public health interventions should focus on rectifying misinformation and enhancing digital health literacy among adolescents.